Device programmer with enclosed imaging capability

ABSTRACT

Methods and electronic tools for imaging a chest region of a patient and communicating with a heart stimulation device used by the patient are disclosed. The electronic tool may include a communications device for two-way data transmission of signals encoded with information to and from the heart stimulation device. The tool may also include an imaging device for radiating energy onto the chest of the patient and receiving energy as it is reflected from the chest region to produce an image signal. The tool may include a display screen for showing an image of the chest area and/or the information received from the heart stimulation device. The tool may also include a processor for formulating and/or analyzing information sent to and/or received from the heart stimulation device. One method of using the electronic tool includes analyzing the image signal and/or received information to provide instructions to the heart stimulation device.

RELATED APPLICATION

This application is a continuation-in-part and claims priority ofinvention under 35 U.S.C. §120 from U.S. application Ser. No.09/905,562, filed Jul. 13, 2001, now U.S. Pat. No. 6,704,600 which isincorporated herein by reference.

TECHNICAL FIELD

The present invention is directed to imaging systems and programmers forcardiac devices. More particularly, the present invention is directed tothe combination of device programmers with imaging systems.

BACKGROUND

Cardiac devices, such as pacemakers and implantable cardiacdefibrillators, have electrical leads that must be implanted within oronto the surface of the heart. The electrical leads may be used todetect electrical events occurring in the heart and to pass anelectrical signal caused by the electrical event to the cardiac device.The electrical leads may also be used to provide electrical stimulationfrom the cardiac device to the heart tissue. The electrical stimulationcauses contraction of the heart tissue. For example, electricalstimulation can be provided to the heart to vary the delay between thedepolarization of the atrial area and depolarization of the ventriclearea.

To properly install the electrical leads of the cardiac device,sophisticated imaging systems such as fluoroscopy are typically used toprovide a high resolution X-ray of the patient's chest as the leads arebeing inserted. Generally, the sophisticated imaging systems arepermanently located in electrophysiology or surgical rooms, andimplantation of the device must occur at these locations.

In addition to the sophisticated imaging system, the physician employs adevice programmer to adjust performance parameters of the implantabledevice. The programmer generally uses telemetry to send and receivesignals, such as magnetic waves, to and from the implantable device.Thus, the physician uses the imaging system to view and position theelectrical leads and to view the hemodynamic response of the heart.While viewing the leads and response, the physician also adjusts theoperational parameters of the device with the programmer to alter thehemodynamic response.

Therefore, there is a need for a tool that allows installation of theleads in a less rigorous medical environment while simplifying theevaluation and optimization of device performance.

SUMMARY

The present invention addresses problems such as but not limited tothose mentioned above by providing an electronic tool having aprogrammer system and an imaging system. A device programmer istypically portable and by combining an imaging system such as ultrasoundwith the programmer in the electronic tool, the implantation process maybe performed in environments other than surgical labs. Furthermore, thetool provides a display that may show an image of the patient's heartincluding the electrical leads while simultaneously showing ordinaryprogrammer information such as electrogram signals received from theimplantable device. The tool may also provide a processor to analyze theimage for lead position and hemodynamic response and may also analyzethe electrogram signals. From this analysis, the tool may communicatesignals to alter the device parameters and improve hemodynamic response.

The present invention may be viewed as an electronic tool forcommunicating with a heart stimulation device and for imaging a chestregion of a patient. The tool includes an enclosure and an imagingdevice at least partially disposed within the enclosure. The imagingdevice radiates energy onto the chest region and detects energyreflected by the chest region to produce an image signal. The tool alsoincludes a communication device at least partially disposed within theenclosure that sends to or receives from the heart stimulation device afirst signal with encoded information.

The invention may be viewed as another electronic tool for communicatingwith a heart stimulation device and for imaging a chest region of apatient. The electronic tool includes an imaging device that radiatesenergy onto the chest region and that detects energy reflected by thechest region to produce an image signal. The tool includes acommunication device that sends to or receives from the heartstimulation device a first signal with encoded information. At least onedisplay screen is in electrical communication with the imaging deviceand the communication device, and the display screen displays arepresentation of the image signal or displays information from thefirst signal sent from or received by the communication device.

The present invention may be viewed as another electronic tool forcommunicating with a heart stimulation device and for imaging a chestregion of a patient. The electronic tool includes an imaging device thatradiates energy onto the chest region and that detects energy reflectedby the chest region to produce an image signal. The tool includes acommunication device that receives a first signal with encodedinformation from the heart stimulation device. At least one processingdevice is in electrical communication with the imaging device or thecommunication device, wherein the at least one processing deviceanalyzes the image signal or analyzes the information encoded on thefirst signal to formulate an instruction for the heart stimulationdevice.

The present invention may be viewed as another electronic tool forcommunicating with a heart stimulation device and for imaging a chestregion of a patient. The tool includes means for radiating energy ontothe chest region and for detecting energy reflected by the chest regionto produce an image signal. The tool includes means for radiating afirst signal with encoded information onto the heart stimulation device.The tool also includes means for formulating the first signal based atleast on the image signal.

The present invention may be viewed as a method of programming a heartstimulation device having one or more electrical leads placed in a heartof a patient. The method involves radiating energy onto an area aroundthe heart of the patient and receiving energy reflected by the one ormore electrical leads positioned in the heart. The method furtherinvolves producing an image signal representative of the received energyand analyzing, with a processing device, the image signal to measuremotion of the electrical lead. The method also involves producing, withthe processing device and in response to the measured motion of theelectrical lead, a signal encoding instructions for varying stimulationone or more stimulation parameters of the heart stimulation device.

The present invention may be viewed as a method for positioning anelectrical lead of a heart stimulation device in a heart of a patient.The method involves radiating, with an imaging device at least partiallywithin a first enclosure, energy onto an area around the heart of thepatient and receiving energy reflected by the electrical lead positionedin the heart. The method further involves producing an image signalrepresentative of the received energy and involves receiving, with acommunications device at least partially within the first enclosure, anactivity signal radiated from the heart stimulation device. The methodalso involves displaying, on a display screen, a first representation ofthe image signal and a second representation of the activity signal.

The present invention may be viewed as an electronic tool forcommunicating with a heart stimulation device and for imaging a chestregion of a patient. The electronic tool includes an imaging device thatradiates energy onto the chest region and that detects energy reflectedby the chest region to produce an image signal. The tool includes acommunication device that radiates a first signal with encodedinformation to the heart stimulation device. The tool also includes atleast one processing device in electrical communication with the imagingdevice and the communication device, wherein the at least one processingdevice analyzes the image signal to formulate an instruction for theheart stimulation device that is encoded onto the first signal.

The present invention may be viewed as a method of programming a heartstimulation device of a patient. The method involves radiating, with animaging device, energy onto an area around the heart of the patient andinvolves receiving, with the imaging device, energy reflected by thearea around the heart. The method also involves producing, with theimaging device, an image signal representative of the received energy,and involves receiving a first signal radiated by the heart stimulationdevice. The method further involves analyzing, with a processing devicein electrical communication with the imaging device and thecommunications device, the first signal to measure a response of theheart. Additionally, the method involves producing, with the processingdevice and in response to the measured response, a second signalencoding instructions for varying one or more stimulation parameters ofthe heart stimulation device.

DESCRIPTION OF THE DRAWINGS

FIG. 1 illustrates a block diagram of the components of one embodimentof the present invention.

FIG. 2 shows an exterior of an electronic tool according to a preferredembodiment incorporating a display screen, keyboard, and stylus.

FIG. 3 depicts an exemplary operational flow of the processing steps ofone embodiment of the present invention.

FIG. 4 shows an exemplary operational flow of an optimization step ofthe embodiment of FIG. 3.

FIG. 5 illustrates an exemplary operational flow of another preferredembodiment.

FIG. 6 illustrates an exemplary screen display provided by oneembodiment.

DETAILED DESCRIPTION

Various embodiments of the present invention will be described in detailwith reference to the drawings, wherein like reference numeralsrepresent like parts and assemblies through the several views. Referenceto various embodiments does not limit the scope of the invention, whichis limited only by the scope of the claims attached hereto.

Embodiments of the present invention include an electronic tool forapplication to various activities such as electrical lead placement andimplantable device optimization. Providing an imaging system with adevice communication system allows a single tool to obtain images of thelead position and the hemodynamic response as well as obtain datasignals indicative of the hemodynamic response while also communicatinginstructions to the implantable device to control its operation. Aprocessing system may be included within the tool to facilitateautomatic analysis and corresponding parameter optimization. A displaymay be included to facilitate user visualization of the lead positionand/or hemodynamic response. Including an input device within the toolallows the user to influence the instructions communicated to theimplantable device.

FIG. 1 shows a block diagram of an exemplary electronic tool 100incorporating programming and imaging functions. The tool 100 in thisexample includes an imaging device such as an ultrasoundtransmitter/receiver module 136 that sends and receives electricalsignals through line 134 to a phased array transducer 104. The phasedarray transducer 104 generates ultrasound energy waves 106 that radiateonto the chest of the patient having an implantable device 122. Theheart 102 of the patient may have several electrodes installed includingan atrial electrode 114, a right ventricle electrode 110, and a leftventricle electrode 112. These electrodes are electrically connected tothe implantable device 122 through leads 126, 128, and 130. Forembodiments where an ultrasound imaging device 136 is used, the leads126, 128, and 130 and the electrodes 110, 112, and 114 may be coatedwith an echogenic material that is opaque to ultrasound energy. Theultrasound imaging device may employ circuitry such as that known in theart for ultrasound imaging.

The transmitter/receiver module 136 is in electrical communication witha processor 146 through line 138. The transmitter/receiver module 136passes an image signal created from the reception of ultrasound energyby the phased transducer array 104 to the processor 146. The imagesignal may contain digital data created by an analog-to-digitalconversion implemented by the transmitter/receiver module 136. Theprocessor 146 may then employ image processing techniques to the imagesignal data to analyze various aspects of the signal, as is discussedbelow. Alternatively, or in addition to feeding the image signal to theprocessor 146, the transmitter/receiver module 136 may feed the imagesignal directly to a display device 162 for real-time display of arepresentation of the image signal.

The electronic tool 100 also includes a communications device such as atelemetry module 140. Telemetry module 140 receives signals from theprocessor 146 through line 144 and provides signals to the processorthrough line 142. Telemetry module 140 sends and receives signals from aloop antenna 116, which typically is a wire loop. The loop antenna 116radiates electromagnetic energy in the form of a signal 118. The signal118 generally has encoded information such as instructions for theimplantable device 122 or trending data to be stored by the implantabledevice 122. The telemetry communications device 140 may use circuitrysuch as that known in the art for implantable device communications.

The implantable device 122 receives the signal 118 from the loop antenna116 and includes its own processing device for interpreting the encodedinformation and carrying out the instruction. Typically, the instructioninvolves adjusting the timing of the stimulation pulse provided to oneof the electrodes in the heart 102. The implantable device 122 generallyincludes memory 124 such as for storing instructions received from theloop antenna 116. The memory 124 may also store trending information,such as electrogram information that is recorded by the implantabledevice 122 through the detection of electrical events by the electrodes110, 112, and 114 in the heart 102. Other trending information that maybe stored by memory 124 includes but is not limited to heart size andleft ventricle septum-lateral wall synchronization.

The implantable device 122 radiates a signal 120 that also has encodedinformation, such as electrogram data being measured in real-time by theelectrodes 110, 112, and 114 or trending data that is stored by memory124. The radiated signal 120 is received by the loop antenna 116 and isconverted to an electrical signal that is transferred to the telemetrymodule 140. The telemetry module 140 may then employ ananalog-to-digital conversion to convert the received signal to a datasignal that is then passed to the processor 146. Alternatively, or inaddition to feeding received signals to the processor 146, the telemetrymodule 140 may feed signals directly to the display device 162 forreal-time display of the information encoded on the signal 120.

In an alternative embodiment, antenna 116 is of a type optimallyconfigured for transmitting and receiving RF signals. The RF antennaradiates electromagnetic energy in the form of an RF signal 118. Thesignal 118 generally has encoded information such as instructions forthe implantable device 122 or trending data to be stored by theimplantable device 122. In an embodiment utilizing RF data signals, thetelemetry communications device 140 may use basic RF base stationcircuitry such as that known in the art for a basic RF system.

The implantable device 122, which also includes RF circuitry that allowsthe implantable device 122 to perform as a mobile RF terminal, has acommunications link with the telemetry communications device 140 viaantenna 116. The implantable device 122 receives the signal 118 from theantenna 116 and includes its own processing device for interpreting theencoded information and carrying out the instruction.

RF technology provides for wireless transmission of data by digitalradio signals at a particular frequency. It provides a means formaintaining bi-directional or two-way, online radio connection betweenthe telemetry communications device 140 and the implantable device 122.

The processor 146 may employ various operations, discussed in moredetail below with reference to FIGS. 3, 4, and 5 to utilize the signalsreceived from the imaging device 136 and/or the communications device140. The processor 146 may store data to and access data from storagedevice 152, such as electronic memory or magnetic storage. Data istransferred to the storage device 152 through line 154, and data isreceived from the storage device 152 through line 156. The processor 146may be a general-purpose computer processor or processor typically usedfor a programmer. Furthermore as mentioned below, the processor 146, inaddition to being a general-purpose programmable processor, may befirmware, hard-wired logic, analog circuitry, other special purposecircuitry, or any combination thereof.

The processor 146 may also transfer a display signal to a display device162 through line 164. The display signal may include the image signalproduced by the imaging device 136 as well as an information signalproduced by communication device 140. The image signal component fromthe imaging device 136 is typically an ultrasound image. The informationsignal component from the communications device 140 is typically anelectrogram. The display device 162 then displays on a screen arepresentation of the ultrasound image and/or a representation of theelectrogram, which can be seen in more detail with reference to FIG. 6discussed below.

The electronic tool 100 may also include a printer 158 to produce apaper copy of the display. The printer 158 receives the data signal forthe paper copy through line 160. An input device 148 may also beincluded with the electronic tool 100. The input device 148 may includeone or more various input interfaces, such as a keyboard, mouse, orstylus. The input device 148 communicates with the processor 146 throughline 150.

FIG. 2 shows an external view of the electronic tool 100 according to apreferred embodiment of the present invention. The tool 100 includes theexternal transducer 104 for sending and receiving ultrasound energy usedfor creating images. The tool 100 also includes an antenna 116 forsending and receiving modulated electromagnetic signals that mayestablish bi-directional communications with the implantable device 122.The tool 100 that is shown includes an input device 148 (see FIG. 1.)having both a keyboard 172 and a stylus 166 that allow the user to inputinformation such as function selections. The stylus 166 communicateswith the input device module 148 through line 168.

The electronic tool 100 also includes a display screen 170 controlled bythe display device 162. The display screen 170 may be a liquid crystaldisplay (LCD) or other display type such as a cathode ray tube (CRT).The display screen 170 may show various forms of information, such asprogrammer menus, device parameter settings, the image generated by theimage device 136, and any information sent or received by thecommunications device 140.

The electronic tool 100 may be enclosed within a housing 174 made ofmetal, plastic, or other rigid material. The keyboard 172 and displayscreen 170 may be integrated into the housing 174 such that theelectronic tool is enclosed within a single housing. Alternatively,multiple housings may be provided for various components, such asincluding a first housing for the display screen 170, a second housingfor the keyboard 174, a third housing for the processor 146, a fourthhousing for communications device 140, and a fifth housing for theimaging device 136.

FIG. 3 shows the operational flow 186 of the processing steps of oneembodiment whereby the operation of the heart stimulation device 122 isoptimized. The process begins by the processor 146 receiving an inputselection from a user at selection operation 176. The display screen 170may provide a user interface that allows the user to make selectionsfrom menus. A measurement menu may be provided to display the responsemeasurements that the user can select to optimize. These may include butare not limited to ejection fraction, stroke volume, end diastolicvolume, E/A (early wave/atrial kick) separation, cardiac output, andwall synchronization of the septum-lateral wall displacement. Using aninput device 148, the user then selects the desired measurement(s) tooptimize.

After receiving the measurement selection(s), the processor 146 thenconfigures the imaging device 136 to produce an image type thatcorresponds to the selected measurement(s) at configure operation 178.For example, if cardiac output or stroke volume is desired, theprocessor 146 may configure the imaging device 136 to produce an aorticflow image rather than an ordinary image of the heart. The operator thenplaces the transducer 104 over the aorta. If volume and ejectionfraction measurements are desired, the processor 146 may configure theimaging device 136 to produce a ventricular cross-section image, and theoperator places the transducer 104 over the ventricle. If a fillingprofile measurement is desired, the processor 146 may configure theimaging device 136 to produce a mitral flow image, and the operatorplaces the transducer 104 over the mitral valve.

Once the imaging device 136 has been properly configured, the processor146 may then receive a selection from the user from a menu of deviceparameters that may be varied to alter the chosen measurement. Theparameters may include but are not limited to the atrial-ventricular(A/V) delay, the lower rate limit, the sensed A/V offset, the maximumsensor rate, the maximum tracking rate, and the right ventricle-leftventricle delay. For certain parameters, processor 146 may accept rangesentered by the user, such as an upper and lower limit to theatrial-ventricular (A/V) delay. By this point, the imaging device 136may be providing the appropriate image signal to the processor 146,which then extracts the measurement(s) from the image signal anddisplays the measurement(s) on the display screen 170. A representationof the image signal itself may also be displayed so the operator mayvisualize the response of the heart.

After the desired parameter and corresponding range have been entered,the processor 146 begins to optimize the measurement(s) at optimizeoperation 182 by varying the chosen parameter within the range bycommunicating instructions to the heart stimulation device 122. Theoptimization process is discussed in more detail below with reference toFIG. 4. Once the measurement(s) taken from the image signal reaches theoptimum value, the optimization process terminates and the current valueof the parameter(s) is taken to be the optimal value for the chosenmeasurement(s). The processor 146 may make other measurements at thisoperation as well, such as those to be stored by the tool 100 or theheart stimulation device 122 for trending purposes includingmeasurements such as heart size that cannot be altered through deviceparameter manipulation.

The processor 146 then programs the heart stimulation device 122 withthe optimal value(s) for the parameter(s) at program operation 184. Theprocessor passes the programming instruction including the parameter(s)and optimal value(s) to the heart stimulation device 122 through atelemetered signal provided by the communications device 140. Theprogram operation 184 may also involve the processor 146 sending aprogramming instruction including a measurement, such as the previouslyselected measurement or another, that is to be stored in the memory 124of the processing device so that it can be retrieved by the electronictool 100 at a later date for trending purposes.

As discussed above, FIG. 4 shows the optimization step 182 in greaterdetail. The optimization step 182 begins by the processor 146 receivingthe image signal taken from the imaging device 136 at image operation188. At this point, the processor 146 may also be streaming the imagesignal to the display device 162 for display on the display screen 170,or the image device 136 may provide the image signal to the displaydevice 162 directly.

The processor 146 then processes the data of the image signal at processoperation 190 to make the selected measurement(s) by using imageprocessing techniques known in the art. For example, the processor 146may measure the velocity from the aortic flow image and integrate thevelocity with respect to time when determining cardiac output. Inanother example, to measure lateral wall displacement, the processor 146may detect and measure motion of an echogenic lead located on thelateral wall. Once the measurement(s) are obtained, the measuredvalue(s) are compared to an optimum value(s) at compare operation 192.In the lateral wall displacement example, the optimum value may be athreshold displacement that must be reached or exceeded to be optimal.The optimum value for each measurement may be one that is stored inmemory 152 of the tool 100 or one that is specified by the user whenselecting the tool at selection operation 176 of FIG. 3.

After the comparison has occurred, query operation 194 detects whetherthe measurement(s) equal the optimum value(s), or exceeds it in the caseof some measurements such as lateral wall displacement. If so, then theoptimization operation 182 reaches stop operation 198 and operationproceeds to program operation 184 of FIG. 3. If query operation 194detects that the measurement(s) are not equal to the optimum value(s) oris some cases whether the measurement is less than the optimum value,then parameter operation 196 triggers the processor 146 to generate aninstruction that alters the parameter value(s) within the heartstimulation device 122 by sending the instruction through a signalprovided by communications device 140.

After allowing for the heart stimulation device 122 to implement the newparameter value(s) and allowing the patient's heart 102 to respond tothe change, receive operation 188 again retrieves an image signalcontaining the data showing the heart's response to the change. Theoptimization process 182 then repeats continuously until themeasurement(s) equal the optimum value(s). Finding that themeasurement(s) do equal, or is some cases exceeds, the optimum value(s)may require determining whether the measurement(s) lie within apermissible tolerance range centered about the optimum value(s).

FIG. 5 shows another process that may be implemented using the tool 100.This process 200 involves placing leads of the heart stimulation device122 within the heart 102 of the patient. This process 200 begins by theprocessor 146 retrieving the image signal from the imaging device 136 atimage operation 202. For determining lead placement, the image signalwill typically be an actual picture of the heart 102. The processor 146retrieves a data signal from the communications device 140 at dataoperation 204. The data signal may be an intracardiac electrogramsignal, a pacing impedance signal, or other device/lead parametersignals that are useful in optimizing the lead position.

At representation operation 206, a representation of the image signal(i.e., an actual picture of the heart) is displayed on the displayscreen 170, which also displays a representation of the data signal(i.e., an electrogram, etc.). Displaying both the representation of theimage signal and the representation of the data signal permits the userto see both the electrical and mechanical responses of the heart 102 andpermits the delay between the two to be observed. The process continuesto query operation 208, which detects whether the lead is in a properposition. The query operation 208 may function by prompting the user toindicate through the input device 148 that the lead has reached a properlocation. Alternatively, the processor 146 may analyze the data signalto determine whether the lead has a proper location based on variousmeasurements of heart activity. If no indication of proper location isdetected, operation returns to receive operation 202 where the procedureis repeated.

Once query operation 208 finds that the lead is in a proper location,the processor 146 analyzes the data signal to find optimal parametersettings at analyze operation 207. For example, the processor 146 maydetermine the natural A/V delay from the data signal by using the leadas a sensor to detect intrinsic heart activity. From this analysis, theprocessor 146 can determine optimal parameter settings. After completingthe analysis, the processor 146 formulates an instruction including theoptimal parameter settings that are then transmitted to the heartstimulation device 122 with the communications device 140 at programoperation 209.

FIG. 6 shows an example of the contents 210 of display screen 170 of theelectronic tool 100. The contents 210 of this embodiment include a menuarea 212 that includes measurement selections 214 and parameterselections 218. Also, measurement area 216 is included to show thecurrent measurement value, and parameter area 220 is included to receiveand show the current parameter range. As shown, the selected measurementis cardiac output and it has a current measured value of 5.1 liters perminute. The selected parameter is A/V delay and the designated range isfrom 30 to 200 milliseconds

The contents 210 of the screen 170 also include an image area 222 fordisplaying a representation of the image signal, such as displaying anactual picture of the heart or an image of flow. As shown, an image offlow through the mitral valve is being displayed in the image area 222.The display may also include an external cardiac signal area 224 fordisplaying a representation of a data signal, such as an external orsurface electrocardiogram. The external electrocardiogram signal mayoriginate from an EKG machine that feeds an output signal into an analoginput port forming part of input device 148 (See FIG. 1). The analoginput port may then direct the output signal to the display device 162.Alternatively, the EKG functionality could be included as part of thefunctionality of the tool 100.

The contents 210 of the display screen 170 also include an intracardiacsignal area 226. This area is for displaying a representation, such asan intracardiac electrogram, of a data signal received by thecommunications device 140 from the heart stimulation device 122.Supplemental image area 228 is also included in the display screen 170to show an actual but limited image of image of the heart to indicate tothe user where the transducer 104 is located relative to the heart 102.The supplemental image area 228 is useful when a flow image is to beused and the user must position the transducer 104 over the aorta or aparticular valve where flow is to be measured.

The embodiments of the operations of the invention, such as but notlimited to those of FIGS. 3, 4, and 5 are implemented as logicaloperations in the system. The logical operations are implemented (1) asa sequence of computer implemented steps running on a computer system ofthe electronic tool comprising a processing module such as processor 146and/or (2) as interconnected machine modules running within thecomputing system.

This implementation is a matter of choice dependent on the performancerequirements of the computing system implementing the invention.Accordingly, the logical operations making up the embodiments of theinvention described herein are referred to as operations, steps, ormodules. It will be recognized by one of ordinary skill in the art thatthe operations, steps, and modules may be implemented in software, infirmware, in special purpose digital logic, analog circuits, and anycombination thereof without deviating from the spirit and scope of thepresent invention as recited within the claims attached hereto.

While the invention has been particularly shown and described withreference to preferred embodiments thereof, it will be understood bythose skilled in the art that various other changes in the form anddetails may be made therein without departing from the spirit and scopeof the invention.

1. A method of programming a heart stimulation device of a patient, themethod comprising the steps of: generating, with an imaging device, animage signal representative of an image of an area around the heart;receiving a first signal transmitted by the heart stimulation device;analyzing, with a processing device in electrical communication with theimaging device and a communications device, the first signal to measurea response of the heart; and producing, with the processing device andin response to the measured response, a second signal encodinginstructions for varying one or more stimulation parameters of the heartstimulation device.
 2. The method of claim 1, further comprising a stepof communicating the second signal to the heart stimulation device. 3.The method of claim 1, further comprising a step of displaying arepresentation of the image signal and a representation of the firstsignal on a display screen.
 4. The method of claim 1, further comprisinga step of positioning leads of the heart stimulation device within theheart, wherein the image signal and the response extracted from thefirst signal indicate the position of the leads, and wherein theinstructions encoded by the second signal are based upon the position ofthe leads.
 5. The method of claim 1, comprising altering anatrial-ventricle delay using information generated with the imagingdevice.
 6. The method of claim 1, comprising altering a rightventricle-left ventricle delay using information generated with theimaging device.
 7. The method of claim 1, comprising altering asynchronization of a septum-lateral wall displacement using informationgenerated with the imaging device.
 8. The method of claim 1, comprisingmeasuring an aortic flow from the image signal.
 9. The method of claim1, comprising measuring a ejection fraction from the image signal. 10.The method of claim 1, comprising measuring a size of the heart of thepatient from the image signal.
 11. An electronic tool for communicatingwith an implantable heart electrostimulation device and for imaging achest region of a patient, the electronic tool comprising: an imagingdevice that radiates energy onto the chest region and that detectsenergy reflected by the chest region to produce an image signal; acommunication device that receives a first signal with encodedinformation from the heart electrostimulation device; and at least oneprocessor in electrical communication with the imaging device and thecommunication device, wherein the at least one processor formulates aninstruction for the heart electrostimulation device by analyzing theimage signal or by analyzing the information encoded on the firstsignal.
 12. The electronic tool of claim 11, further comprising: adisplay screen that is communicatively linked to the imaging device andthat displays a representation of the image signal or a representationof the encoded signals.
 13. The electronic tool of claim 11, wherein theprocessor communicates with the imaging device, analyzes the imagesignal, and formulates a first signal that is sent to the heartelectrostimulation device.
 14. The electronic tool of claim 11, whereinthe encoded signals include a first signal that is received from theheart stimulation device by the communication device, the processor thatcommunicates with the communication device is configured to analyze thefirst signal and to formulate a second signal, wherein the communicationdevice sends the second signal to the heart electrostimulation device.15. The electronic tool of claim 11, further comprising: at least onedisplay screen in electrical communication with the imaging device andthe communication device, wherein the at least one display screenincludes a display of a representation of the image signal or a displayof information from the first signal sent from or received by thecommunication device.
 16. The electronic tool of claim 11, wherein thefirst signal is sent by the communications device, the electronic toolfurther comprising: an input device configured for receiving inputinformation from a user, wherein the at least one processor analyzes theinformation received by the input device to formulate the informationencoded on the first signal.
 17. The electronic tool of claim 11,wherein the imaging device comprises an ultrasound transducer array thatradiates and receives ultrasound energy.
 18. The electronic tool ofclaim 11, wherein the communications device comprises a wire loop thatradiates and receives magnetic signals.
 19. The electronic tool of claim11, wherein the communications device includes an RF antenna thattransmits and receives RF signals.
 20. The electronic tool of claim 11,wherein the heart electrostimulation device has electrical leads locatedin the patient's chest area that reflect energy radiated by the imagingdevice and wherein the imaging device detects the energy reflected bythe electrical leads to produce an image signal that causes theelectrical leads to appear on the display screen.
 21. The electronictool of claim 11, wherein the processor formulates the instruction suchthat the instruction is configured to alter an atrial-ventricle delay.22. The electronic tool of claim 11, wherein the processor formulatesthe instruction such that the instruction is configured to alter a rightventricle-left ventricle delay.
 23. The electronic tool of claim 11,wherein the processor formulates the instruction such that theinstruction is configured to alter a synchronization of a septum-lateralwall displacement.
 24. The electronic tool of claim 11, wherein theprocessor is adapted to measure an aortic flow from the image signal.25. The electronic tool of claim 11, wherein the processor is adapted tomeasure an ejection fraction from the image signal.
 26. The electronictool of claim 11, wherein the processor is adapted to measure a size ofthe heart of the patient from the image signal.
 27. The electronic toolof claim 11, wherein the instruction comprises a value measured by theprocessor for storage by the heart electrostimulation device.
 28. Anelectronic tool for communicating with an implantable heartelectrostimulation device and for imaging a chest region of a patient,the electronic tool comprising: means for generating an image of thechest region; means for formulating an instruction for the heartelectrostimulation device by analyzing the image; and means fortransmitting information including the instruction to the heartelectrostimulation device.
 29. The electronic tool of claim 28, whereinthe means for generating an image comprises a display screen forproviding a representation of an image signal to a user and an inputdevice for receiving information input by a user that is encoded onto afirst signal transmitted to the heart electrostimulation device.
 30. Theelectronic tool of claim 28, wherein the means for transmittinginformation transmits encoded information as an RF signal.
 31. Theelectronic tool of claim 28, wherein the means for transmittinginformation comprises a means for bi-directional communication of RFsignals.